COMMUNITY-BASED DIAGNOSIS AND MANAGEMENT OF CHILDHOOD MALARIA USING RAPID DIAGNOSTIC TEST AND MANAGEMENT WITH ARTEMISININ –BASED COMBINATION THERAPY IN TARABA STATE-NIGERIA

CHAPTER ONE

INTRODUCTION AND LITERATURE REVIEW

1.1  Introduction

Malaria, a term meaning bad air was so named because of its presumed association with obnoxious air of swamps especially at night (Chandler and Read, 1961). Due also to its association with swamps in humid regions of the world, it was called marsh fever (Greenwood and Pickering, 1999). It is a mosquito borne protozoan disease and is well known as one of the world’s worst scourges. About 56% of the world population live in malarious areas and most are subject to frequent infections, which become less severe with increasing age because of the previously developed immunity. It is estimated that 100 million symptomatic infections occur annually (Renato, 1991). Malaria is a leading cause of mortality and morbidity worldwide especially in pregnant women and children living in sub- Saharan Africa where 90% of malaria deaths occur (WHO/UNICEF, 2003).

Recent estimates by WHO suggest that 3.3 billion people are at risk of malaria in 106 countries and territories (World Malaria Report, 2011). In 2010, about 216 million cases of malaria occurred and resulted in 655,000 deaths of which 91% is in Sub-Saharan Africa and 86% were children under five years worldwide (World Malaria Report, 2011). It further stated that malaria is the third leading cause of death in children under 5 years worldwide after pneumonia and diarrhoea diseases.

Malaria is the most common single diagnosis made in most countries in Africa, but the accuracy of clinical diagnosis is limited by the low specificity of symptoms and signs. The malaria burden especially in Africa, South of the Sahara can be attributed to a number of factors among which are types of diagnostic methods used. It is on record that most malaria patients are treated at home or at community health facility based on either Laboratory-based microscopy or presumptive diagnosis. These two methods have their limitations which usually affect the outcome of the diagnosis and treatment. Laboratory based microscopy is considered the “gold standard” for malaria diagnosis (WHO, 2000).

New rapid diagnostic tests (RDTs) for falciparum malaria are sensitive and specific (although there is marked variation between different makes of the test kits (Hopkins et al., 2007; WHO, 2008; 2009) and can be used in the peripheral settings where most patients in Africa get their care. They do not require microscopes, electricity or trained laboratory staff. RDTs are also potentially cost effective, but only if prescribers use the result to guide their prescribing (Lubell et al., 2008). The fact that most of the first line drugs used in treatment of malaria such as Chloroquine, Amodioquine, Sulfodoxine–Pyrimethiamine (SP), are no more effective in the treatment of malaria episodes is well known. Sequel to these, most African countries have introduced more effective but expensive new antimalarial drugs called ACTs (Artemisinin – Based Combination Therapy). ACT drugs such as Artemether – Lumefantrine,

Artesunate – Amodiaquine, Artequine (Artesunate-Mefloquine) etc are increasingly being used as first – line antimalarials in endemic countries.

1.1.1     Significance of the study

The study on the community-based diagnosis and management of childhood malaria using rapid diagnostic tests and Artemisinin-Based Combination Therapy is of immense importance to the stake holders in health care delivery. This is because malaria causes much physical and economic hardship in Taraba State as in other tropical regions, particularly in communities where medical care is rudimentary. Continued and sustainable improvement in malarial medicines through research and development are essential for future abilities to treat and control malaria both globally and in the state. The inference that can be derived from this study could be used to enhance prompt management of malaria at the community level especially among the vulnerable and the infants in particular. Burden due to malaria morbidity and mortality could be reduced by timely deployment of RDTs for diagnosis followed by treatment at the community level.

1.1.2       General objective of the study

The general objective of the study was to assess the reliability of rapid diagnostic test in diagnosis with a view to recommending ACT for the management of childhood malaria at community level in Northern Taraba.

1.1.2.1. Specific research objectives

The specific objectives of this study were to;

i.  Reassessment of the reliability of RDT in detecting malaria infection in the communities in Taraba State.

ii.    Compare the efficacy of RDT with microscope and presumptive based diagnosis of malaria.

iii.    Determine the efficacy and level of adherence to treatment regime with Atesunate- Amodiaquine at the community level in Taraba State.

iv.  Compare the sensitivity of intradermal smear in detecting malaria parasite with peripheral smear.

v.  Assess communities’ perception of malaria and their treatment seeking behaviours.